Provider Demographics
NPI:1376538009
Name:LEE, CHARLES KEITH (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:KEITH
Last Name:LEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1734 E 63RD ST
Mailing Address - Street 2:STE 206A
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64110-3543
Mailing Address - Country:US
Mailing Address - Phone:816-361-9508
Mailing Address - Fax:816-361-0727
Practice Address - Street 1:1734 E 63RD ST
Practice Address - Street 2:STE 206A
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64110-3543
Practice Address - Country:US
Practice Address - Phone:816-361-9508
Practice Address - Fax:816-361-0727
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9A39208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
C51109Medicare UPIN
MO0005831Medicare ID - Type Unspecified